Indian Health Care Amendments of 1986

(Senate agreed to House amendments to Senate amendment with an amendment)

Indian Health Care Amendments of 1986 - Title I: Indian Health Manpower - Amends the Indian Health Care Improvement Act to authorize appropriations for specified Indian health programs for FY 1987 through 1990, including scholarship programs and continuing education allowances. Provides for a freeze on the total amount to be appropriated for such programs.

Prohibits the Secretary of Health and Human Services (the Secretary) from denying scholarship assistance solely on the basis of an applicant's scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited health professions institution.

Directs the Secretary to grant Indian Health Scholarships to Indians enrolled full-time in certain schools for health professionals. States that the active duty service requirements prescribed under the Public Health Service Act shall be met by a recipient of an Indian Health Scholarship by service or employment: (1) in the Indian Health Service; (2) under a contract pursuant to the Indian Self-Determination and Education Assistance Act; (3) in a program under the Indian Health Care Improvement Act; or (4) in the private practice of his or her health profession if such practice is in a health professional shortage area and addresses the health care needs of a substantial number of Indians.

Repeals the Indian Health Scholarship Program under the Public Health Service Act.

Title II: Health Services - Enumerates the health services for which the Secretary is authorized to expend Indian Health Care Improvement Fund appropriations. Prohibits the use of such funds to offset or limit appropriations made under other Acts. Conditions the allocation of such funds upon the health resource deficiency level of the affected Indian tribes. Allocates such funds on a service unit basis.

Requires the Secretary to submit to the Congress a current health services priority system report, including the methodology for determining tribal health resources deficiencies, the funds needed to raise all tribes to a zero level deficiency, an estimate of the number of Indians eligible for health services in each tribe and service unit, and an evluation of the preventive health, health protection, and the health promotion needs of Indians identified in tribal specific health plans.

Directs the Secretary to establish a review mechanism for tribal petitions regarding the health resource deficiency level of a tribe.

Requires the Secretary to provide a current update of tribal specific health plans.

Requires at least one percent of the Indian Health Care Improvement Fund appropriation to be expended for research. Requires Indian tribes and tribal organizations that contract with the Indian Health Service to be given an equal opportunity to compete for and receive such research funds.

Makes programs administered by tribal organizations under the Indian Self-Determination and Education Assistance Act eligible for specified funds on an equal basis with programs administered directly by the Indian Health Service.

Directs the President to include with the submission of the budget a separate statement which specifies the amount obligated to implement enumerated health services.

Authorizes appropriations for FY 1988 through 1990 for specified health services. Designates such appropriations the Indian Health Care Improvement Fund.

Establishes an Indian Catastrophic Health Emergency Fund to meet the extraordinary medical costs of victims of disasters or catastrophic illness. Authorizes appropriations for FY 1988 through 1990. Requires the Secretary to report to the Congress on the operation of such Fund.

Authorizes the Secretary to waive the competitive procurement requirements for health services upon certification by the responsible Chief Medical Officer that such requirements would compromise the accessibility, continuity or quality of health services or would not result in any appreciable competition or savings.

Requires the Secretary to require each Indian tribe to include within any tribal specific health plan submitted to the Secretary an identification of the preventive health, health protection, and health promotion needs of each such tribe and a comprehensive plan for the provision of such services to such tribe.

Title III: Health Facilities - Requires the Secretary to submit to the Congress a health facilities priority system report, which shall include a report on the construction or renovation needs of the ten top priority inpatient and ambulatory care facilities.

Requires the Secretary to consult with any Indian tribe that might be affected by an expenditure for health facilities before the Secretary makes a commitment for such an expenditure. Conditions the closure (except those closures to avoid jeopardizing the health and safety of patients) of any health care facility upon the Secretary's submission to the Congress of an impact assessment one year prior to the contemplated closing. Enumerates the data to be included in such assessment.

Directs the Secretary to implement a ten-year plan to provide safe water and sanitary sewage and solid waste disposal facilities to Indian homes and communities. Requires the Secretary to report to the Congress, and to consult with any Indian tribe during specified fiscal years, regarding the Indian Health Service's current Indian sanitation facility priority system and the funds needed to raise all communities or tribes to a zero level of deficiency.

Authorizes the Secretary to provide financial and technical assistance for the operation and maintenance of sanitation facilities, utility organizations, and emergency repairs of sanitation facilities. Authorizes appropriations for FY 1988 through 1990.

Authorizes tribes to expend certain non-Indian Health Service funds for the renovation of Indian health facilities, subject to specified conditions.

Authorizes the Secretary to exchange certain real property with the Bethel Native Corporation (Alaska).

Title IV: Access to Health Services - Extends the authorization for specified appropriations for grants and contracts with tribal organizations from FY 1988 through 1990.

Amends title XIX (Medicaid) of the Social Security Act to make certain providers of the Indian Health Service eligible for Medicaid payments. Directs the Secretary to ensure that each service unit of the Indian Health Service receives at least half of the amounts to which its facilities are entitled, if such amounts are necessary to bring the facilities into compliance with this Act.

Directs the Secretary to conduct a study in consultation with Indian tribes regarding barriers to Indian participation in Medicaid programs. Requires the Secretary to report to the Congress regarding such study.

Title V: Urban Indian Health Services - Directs the Secretary to contract with urban Indian organizations to administer health services programs in urban areas. Sets forth specified requirements to be included in such contracts. Lists criteria for the selection of such organizations.

Authorizes the Secretary to enter into contracts with urban Indian organizations to determine the health status and unmet health care needs of urban Indians in affected urban areas. Delineates the requirements of such contracts.

Requires the Secretary to: (1) develop evaluation procedures for the performance of the contracts entered into under this title; and (2) conduct annual onsite evaluations of each contracting urban Indian organization. Prescribes guidelines for the renewal of health care or referral services contracts. Prohibits renewal of contracts for determination of unmet health needs if such an organization's performance has been non-compliant or otherwise unsatisfactory and problems cannot be resolved.

Requires certain reports to the Congress.

Authorizes appropriations for FY 1987 through 1990 for purposes of carrying out such contracts.

Title VI: Organizational Improvements - Establishes the Indian Health Service within the Public Health Service of the Department of Health and Human Services (thus terminating the Indian Health Service as part of the Health Resources and Services Administration). Places the Indian Health Service under a Director who shall report only to the Secretary through the Assistant Secretary for Health of such Department. Directs the Secretary to implement through the Director all health programs and authorities which are provided specifically for Indians.

Requires the Secretary, not later than September 30, 1988, to establish an automated management information system for: (1) the Indian Health Service; and (2) all tribes, tribal organizations, and urban Indian organizations providing health services under certain contracts in California. Provides for patient's access to their health records.

Title VII: Miscellaneous - Authorizes the Secretary to enter into legal agreements with Indian tribes or tribal organizations in order to provide compensation for facility space costs associated with the administration and delivery of health services by the Indian Health Service or tribally operated programs.

Directs the Secretary to coordinate efforts with the Secretary of the Interior and the Secretary of Education to develop programs to combat alcohol and drug abuse among Indian juveniles, including preventive education programs in schools operated by or under the Bureau of Indian Affairs.

Directs the Secretary to establish an Office of Alcohol and Drug Abuse within the Indian Health Service. Authorizes appropriations for FY 1988 through 1990.

Directs the Secretary to arrange with the National Academy of Sciences, to conduct a study of health hazards faced by Indians and Indian miners exposed to nuclear resource developments on or near Indian communities. Directs the Secretary and the Indian Health Service to develop a health care plan which addresses the results of such study. Directs the Secretary to submit to the Congress both the health hazard study and the ensuing health care plan, within certain times. Authorizes appropriations for such study.

Extends to 1989 the time during which Arizona is designated as a contract health service delivery area.

Extends, indefinitely, eligibility for health services to specified Indians in the State of California.

Designates the State of California as a contract health service delivery area.

Lists programs eligible for Indian Health Service funds. Provides for certain alternative health arrangements for eligible California Indians who are not members of a tribe.

Restricts circumstances under which the Secretary may remove a member of the National Health Service Corps who is performing obligated service in a health facility operated by or under the Indian Health Service.

Authorizes the Secretary under certain circumstances to provide medical care or benefits by the Indian Health Service to otherwise ineligible persons.

Requires the Secretary, through the Indian Health Service, to provide services and benefits for Indians in Montana in a manner consistent with a specified Federal case.

Requires the Secretary, with respect to a proposed contract for the operation of the Flathead Indian Irrigation Project Electric Power System, to consult with local government bodies and the Joint Board of Control of the Flathead Indian Irrigation Project while taking into account the interests of the electric power consumers. Directs the Secretary to submit such contract to the appropriate congressional committees.

Sets a deadline by which the Secretary must develop and implement a plan to reduce Indian infant and maternal mortality rates to that of the general population. Requires the Secretary to report to the Congress on the progress of lowering such rates.

Directs the Secretary to provide contract health services to the Turtle Mountain Band of Chippewa Indians who reside in the Trenton Service Area of specified counties in the States of North Dakota and Montana.

Requires the Secretary to examine the feasibility of sharing medical facilities and services between the Indian Health Service and the Veterans' Administration. Requires the Secretary to report to the Congress on such feasibility.

Requires the Secretary to make grants to the Navajo tribe to establish a demonstration program in Gallup, New Mexico, to rehabilitate adult Navajo Indians suffering from alcoholism or alcohol abuse. Authorizes appropriations for FY 1988 through 1990.

Directs the Secretary to conduct a study of the physical and mental health care needs of Native Hawaiians and other Native American Pacific Islanders, and to report the results of such study to the Congress one year after the enactment of this Act.

Requires the Indian Health service to apply, in FY 1987 and 1988, such regulations and policies governing eligibility for health services as were in effect on January 1, 1986.